Chengappa K N Roy, Chalasani L, Brar Jaspreet S, Parepally H, Houck Patricia, Levine Joseph
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2593, USA.
Clin Ther. 2002 Oct;24(10):1576-84. doi: 10.1016/s0149-2918(02)80061-3.
Subsets of psychiatric patients gain excess body weight while receiving mood-stabilizing agents such as lithium carbonate or valproate sodium. Patients who gain excess weight may discontinue therapy, with severe consequences. Among the newer anticonvulsant agents, topiramate is a candidate agent for bipolar disorder and is associated with weight loss when used as adjunctive treatment.
This open-label, nonrandomized, chart-review study assessed changes in body weight and body mass index (BMI) in patients receiving topiramate, lithium, or valproate.
Data were extracted from the medical charts of patients admitted in 1999 and 2000 to a state psychiatric hospital with either schizophrenia, schizoaffective disorder, bipolar disorder, or other psychiatric diagnoses who were prescribed valproate, lithium, or topiramate and were reviewed for changes in body weight and BMI. The use of concomitant psychotropic medicines was recorded (eg, antipsychotic agents, antidepressant agents, other mood stabilizers such as gabapentin or carbamazepine). Continuous variables were analyzed using a factorial analysis of variance and the Student t test. Contingency statistics were used to analyze categorical variables.
A total of 214 patients were included in the chart review (123 men, 91 women; mean age, 39.4 years). Significantly more women than men received topiramate (P = 0.004). Patients receiving either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg, respectively, whereas patients receiving topiramate lost a mean 1.2 (6.3) kg (F = 11.54, df = 2,198; P < 0.001). Lithium- or valproate-treated patients experienced an increase in BMI (mean, 2.1 [3.0] for both groups), whereas topiramate-treated patients experienced a reduction in BMI (mean, -0.5 [2.4]); this result was statistically significant (F = 11.40, df = 2,198; P < 0.001). Finally, lithium- or valproate-treated patients gained >8% of their baseline body weight (8.2% [11.5%] for lithium-treated patients and 8.5% [11.9%] for valproate-treated patients), whereas topiramate-treated patients lost 0.7% (7.2%) of their body weight (F = 9.93, df= 2,198; P < 0.001).
Controlled studies for the efficacy of topiramate therapy in various psychiatric conditions are awaited. These data indicate that patients receiving topiramate experience body weight loss and a reduction in BMI. This advantage of topiramate may promote long-term adherence to treatment among psychiatric patients and possibly decrease the medical risks associated with obesity.
部分精神病患者在接受碳酸锂或丙戊酸钠等心境稳定剂治疗时体重会过度增加。体重增加的患者可能会停止治疗，从而产生严重后果。在新型抗惊厥药物中，托吡酯是治疗双相情感障碍的候选药物，作为辅助治疗使用时与体重减轻有关。
这项开放标签、非随机的病历回顾研究评估了接受托吡酯、锂盐或丙戊酸盐治疗的患者体重和体重指数（BMI）的变化。
数据取自1999年和2000年入住一家州立精神病医院的患者病历，这些患者被诊断为精神分裂症、分裂情感性障碍、双相情感障碍或其他精神疾病，且正在服用丙戊酸盐、锂盐或托吡酯，并对其体重和BMI的变化进行回顾。记录了同时使用的精神药物（如抗精神病药物、抗抑郁药物、其他心境稳定剂如加巴喷丁或卡马西平）的使用情况。连续变量采用方差分析和学生t检验进行分析。使用列联统计分析分类变量。
共有214例患者纳入病历回顾（123例男性，91例女性；平均年龄39.4岁）。接受托吡酯治疗的女性明显多于男性（P = 0.004）。接受锂盐或丙戊酸盐治疗的患者体重平均分别增加了6.3（9.0）kg和6.4（9.0）kg，而接受托吡酯治疗的患者体重平均减轻了1.2（6.3）kg（F = 11.54，自由度 = 2,198；P < 0.001）。接受锂盐或丙戊酸盐治疗的患者BMI有所增加（两组平均均为2.1 [3.0]），而接受托吡酯治疗的患者BMI有所降低（平均为 -0.5 [2.4]）；这一结果具有统计学意义（F = 11.40，自由度 = 2,198；P < 0.001）。最后，接受锂盐或丙戊酸盐治疗的患者体重增加超过其基线体重的8%（锂盐治疗患者为8.2% [11.5%]，丙戊酸盐治疗患者为8.5% [11.9%]），而接受托吡酯治疗的患者体重减轻了0.7%（7.2%）（F = 9.93，自由度 = 2,198；P < 0.001）。
有待进行关于托吡酯治疗各种精神疾病疗效的对照研究。这些数据表明，接受托吡酯治疗的患者体重减轻且BMI降低。托吡酯的这一优势可能会促进精神病患者长期坚持治疗，并可能降低与肥胖相关的医疗风险。
